Abstract 14467: Left Atrial Functional Index is a Predictor of Persistent/permanent Non-valvular Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aditya Bhat ◽  
Henry H Chen ◽  
Shaun Khanna ◽  
Gary C Gan ◽  
Fernando Fernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Characteristic Curve ◽  
Sleep Apnoea ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Obstructive Sleep

Introduction: Chronicity of atrial fibrillation (AF) has been associated with poor cardiovascular outcomes. Left atrial function index (LAFI) is a rhythm-independent measure of LA reservoir function adjusted for LA size and stroke volume and is an established marker of risk for cardiac disease states. We sought to evaluate the role of LA function by LAFI in predicting persistent/permanent AF. Hypothesis: LAFI is a predictor of chronicity of AF. Methods: Patients attending our institution between Jan 2013 and Dec 2017 were assessed. Patients with history of non-valvular AF who received transthoracic echocardiogram (TTE) evaluation were included. In these patients, we evaluated demographic profiles, AF history, clinical comorbidities and echocardiographic data. We excluded patients with valvular AF, poor quality TTE images and incomplete clinical data. Results: Of the 665 patients (67.78±13.62years, 52% male) included, 27.8% had persistent/permanent AF. Persistent/permanent AF was associated with older age (p<0.01), heart failure (p<0.01), diabetes mellitus (p=0.02), ischaemic heart disease (p=0.02), obstructive sleep apnoea (p=0.04), renal impairment (p<0.01), lower left ventricular ejection fraction (p<0.01), higher E/e’ (p<0.01), larger LA volume index (p<0.01) and lower LAFI (p<0.01). Multi-variable analysis revealed both heart failure (OR 3.024, 95%CI 1.737 to 5.265, p<0.01) and LAFI (OR 4.881, 95%CI 2.503 to 9.519, p<0.01) as independent predictors of persistent/permanent AF. Receiver operating characteristic curve showed LAFI (see Figure; AUC 0.75, 95%CI 0.703 to 0.793, p<0.01) of less than 16.5 to have a 70% sensitivity and 70% specificity in detecting persistent/permanent AF. Conclusions: LAFI, an echocardiographic measure of atrial mechanical function, may be a useful tool in risk stratification for patients with non-valvular AF.

Atrial function discriminates paroxysmal AF patients with HFpEF from those without HFpEF: subanalysis from AF-RISK study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Artola ◽  
B Santema ◽  
R De With ◽  
B Nguyen ◽  
D Linz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Atrial Function ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left And Right ◽  
Right Atria

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie. Grant support from the Dutch Heart Foundation [NHS2010B233] Background. Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) are two cardiovascular conditions that often coexist. Overlapping symptoms, biomarker profile, and echocardiographic changes hinder the diagnosis of underlying HFpEF in patients with AF and suggest that both conditions might reflect similar remodelling processes in the heart. Purpose. To assess cardiac remodelling in AF patients with versus without concomitant HFpEF by transthoracic echocardiography, focusing on atrial dimension and strain. Methods. We selected 120 patients included in AF-RISK, a prospective, observational, multicentre study aiming to identify a risk profile to guide atrial fibrillation therapy study. Patients had paroxysmal AF diagnosed within three years before inclusion, had a left ventricular ejection fraction (LVEF) ≥50% and were in sinus rhythm at the moment of performing echocardiography and blood sampling. Patients were matched by nearest neighbour by age and sex with a 1:1 ratio and were classified into two groups: 1) AF with HFpEF (n = 60) and 2) AF without HFpEF (n = 60). The diagnosis of HFpEF was based on the 2016 ESC heart failure guidelines, including symptoms and signs of heart failure, N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125pg/ml, and one of the following echocardiographic measures: left atrium volume index (LAVI) &gt;34ml/m2, left ventricular mass index ≥115g/m2 for men and ≥95g/m2 for women, average E/e’ ≥13cm/s and average e’ &lt;9cm/s. Measurements of reservoir, conduit and contraction strain of both atria were performed in apical four-chamber by echocardiography (GE, EchoPac BT12). Associations of clinical and echocardiographic characteristics were tested for collinearity by multivariable logistic regression analyses. LAVI, LV mass index and NT-proBNP were excluded from multivariable analysis since these markers were part of the HFpEF diagnostic criteria. Results. Patients with paroxysmal AF and concomitant HFpEF had more often hypertension (72% vs. 45%, P = 0.005), had more impaired strain phases of both the left and right atria (figure 1), had comparable LVEF and global longitudinal strain (GLS) (P = 0.168 and P = 0.212, respectively). In a model adjusted for the number of comorbidities and sex, LA contraction decrease was associated with presence of HFpEF (odds ratio per 1% LA contraction-percent was 0.94, 95% confidence interval 0.87–0.99, P = 0.042). LA contraction was not explained by LAVI in patients with concomitant HFpEF (Spearman’s rho= -0.07, P = 0.08). Conclusion. Our results show that atrial function may differentiate paroxysmal AF patients with HFpEF from those without HFpEF. In patients with paroxysmal AF, more impaired strain phases of the left and right atria were associated with concomitant HFpEF, whereas ventricular function, reflected by LVEF and GLS, did not differ. Abstract Figure. Strain distribution of both atria

P3764Morphological mechanisms of atrial functional mitral regurgitation in patients with atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Nagaoka ◽  
Y Mukai ◽  
S Kawai ◽  
S Takase ◽  
K Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Ventricular Ejection Fraction

Abstract Background Atrial functional mitral regurgitation (AFMR) occurs in patients with atrial fibrillation. However, morphological mechanisms of AFMR are poorly understood. Purpose The purpose of this study was to examine the morphological characteristics in patients with AFMR. Methods Among consecutive 795 patients undergoing initial radiofrequency catheter ablation (RFCA) at our hospital, twenty-five patients with persistent AF accompanied by AFMR (≥ moderate) before RFCA (AFMR group) were studied. Age-matched 25 patients with persistent AF without MR were defined as a control group. Results Left ventricular ejection fraction (LVEF) was lower and left atrium volume index was larger in the AFMR group (Table). Mitral valve annulus diameter and length of anterior mitral leaflet (AML) were similar between groups, whereas length of posterior mitral leaflet (PML) was significantly shorter in the AFMR group. Smaller tethering angle of AML (γ in the figure) and shorter tethering height were significantly associated with the occurrence of AFMR, which were different from morphology of functional mitral regurgitation in patients with dilated LV. Multiple regression analysis revealed that less tenting height (p<0.05) and LA dilatation toward the posterior (p<0.01) were significantly related to AFMR. Echocardiographic parameters AFMR (n=25) Control (n=25) P value Age, y 69±8 66±10 NS Male, n (%) 9 (36) 20 (80) P=0.001 LVEF,% 60±9 67±6 P=0.004 LAD, mm 44±5 41±7 NS LAVI, ml/m2 56±17 41±13 P<0.001 MV diameter, mm 3.9±0.4 3.8±0.5 NS α angle, ° 34±9 35±7 NS β angle, ° 48±9 50±8 NS γ angle, ° 32±5 37±5 P=0.0005 AML length, mm 3.0±0.5 3.0±0.5 NS PML length, mm 2.1±0.1 2.4±0.1 P=0.03 Tenting height, mm 1.5±0.1 1.8±0.1 P=0.02 D, mm 0.8±0.3 0.5±0.3 P=0.001 LVEF: left ventricular ejection fraction; LAD: left atrial diameter; LAVI: left atrial volume index; AML: anterior mitral leaflet; PML: posterior mitral leaftlet. Conclusions AFMR occurs in patients with unique morphological features, such as less tethering height and LA dilatation toward the posterior.

Abstract 17788: Association of Left Atrial Function and Left Atrial Fibrosis in Patients with Atrial Fibrillation: a Cardiac Magnetic Resonance Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mohammadali Habibi ◽  
Joao Lima ◽  
Irfan Khurram ◽  
Stefan L Zimmerman ◽  
Vadim Zipunnikov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Feature Tracking ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Physiological Importance

Introduction: Atrial fibrillation (AF) is associated with left atrial (LA) electrical, structural, and contractile remodeling. Cardiac magnetic resonance (CMR), late gadolinium enhancement (LGE) and feature tracking are capable of noninvasive quantification of LA fibrosis and myocardial motion, respectively. Hypothesis: Increased LA fibrosis measured with LGE is associated with worsening of the phasic LA function measured with feature tracking CMR. Methods: The cohort included 90 patients (age 61 ± 10 years, 76% male) with symptomatic drug-resistant AF referred for ablation. Peak global longitudinal LA strain (PLAS), LA systolic strain rate (SR-s), and early (SR-ed) and late diastolic (SR-ld) strain rates were measured using cine-CMR images acquired during sinus rhythm. The degree of LGE was quantified using normalized image intensity. Results: Compared to patients with paroxysmal AF (60% of cohort), those with persistent AF had larger maximum LA volume index (LAVImax, 56 ± 17ml/m2 versus 49 ± 13ml/m2 p=0.036), and increased LGE (27.1± 11.7% versus 36.8 ± 14.8% p<0.001). Aside from LA active emptying fraction, all LA parameters (passive emptying fraction, PLAS, SR-s, SR-ed and SR-ld) were lower in patients with persistent AF (p< 0.05 for all). Increased LA fibrosis was associated with lower LA passive emptying fraction, PLAS, SR-s, SR-ed, and SR-ld after adjusting for age, sex, hypertension, heart failure, left ventricular ejection fraction, type of AF, and LA volume (p<0.05 for all). Conclusions: Increased LA fibrosis is associated with decreased LA reservoir, conduit, and booster pump functions. Phasic measurement of LA function using feature-tracking CMR is feasible and may add important information regarding the physiological importance of LA fibrosis.

Impact of left atrial appendage closure on left atrial hemodynamics: a prospective single center study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Mertens ◽  
N Bouziri ◽  
P Guedeney ◽  
G Duthoit ◽  
A Redheuil ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Clinical Issue ◽  
Ventricular Ejection Fraction ◽  
Mean Pressure ◽  
The Impact

Abstract Background Percutaneous left atrial (LA) appendage closure is increasingly used to prevent strokes in patients with atrial fibrillation (AF). While LA appendage plays a key role in LA physiology, data regarding the impact of LA appendage occlusion on LA hemodynamics are lacking. The alteration of LA compliance by LA appendage occlusion may represent a clinical issue in AF patients which are at high risk of heart failure. Purpose To describe the impact of LA appendage occlusion on LA hemodynamics. Material and methods From july 2015 to january 2020, all patients undergoing LA occlusion procedure at Pitié-Salpêtrière Hospital (Paris, France) in whom LA pressure curves were recorded, before and immediately after device implantation, were included. The LA mean pressure was measured at baseline and after LA appendage occlusion during the same procedure. Abnormal LA mean pressure was defined as &gt;15mmHg. We also recorded cardiovascular death and hospitalization for congestive heart failure at longest follow-up. Results We enrolled 85 patients (78±8 years, 46 men), the CHA2DS2-VASc score was 5±1 and the HAS-BLED score was 4±1. The mean LA volume index was 51±15mL/m2, the left ventricular ejection fraction was 60±7%. The LA mean pressure increased significatively after LA appendage closure from 12.6±3.9mmHg to 15.5±5.2mmHg (p&lt;0.0001, Figure). The prevalence of abnormal LA pressure was 20% (17/85) at baseline and 45% (38/85) after LA appendage closure (p=0.005). Post procedural LA pressure elevation was not related to procedure duration nor to fluid expansion volume. During a median follow-up of 364 [124–726] days, 3 (3.5%) patients died from a cardiovascular cause. Hospitalization for heart failure occurred in 6 (16%) of the 38 patients with abnormal postprocedural LA pressure, whereas no congestive episode was observed in the rest of the study population (p=0.006). Conclusion Catheter-based LA appendage occlusion induces an acute alteration of LA hemodynamics. Post procedural abnormal LA pressure may be linked to heart failure episodes in some patients. Further studies are warranted to investigate heart failure as a potential late complication of LA appendage closure. Variations of mean LA pressure Funding Acknowledgement Type of funding source: None

Left atrial fibrosis predicts left ventricular ejection fraction response after atrial fibrillation ablation in heart failure patients: the Fibrosis-HF Study

EP Europace ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. 1812-1821
Author(s):  
Bettina Kirstein ◽  
Sebastian Neudeck ◽  
Thomas Gaspar ◽  
Judith Piorkowski ◽  
Simon Wechselberger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Atrial Fibrosis ◽  
Ventricular Ejection Fraction ◽  
Af Ablation ◽  
Left Atrial Fibrosis

Abstract Aims Atrial fibrillation (AF) and heart failure (HF) often coexist. Catheter ablation has been reported to restore left ventricular (LV) function but patients benefit differently. This study investigated the correlation between left atrial (LA) fibrosis extent and LV ejection fraction (LVEF) recovery after AF ablation. Methods and results In this study, 103 patients [64 years, 69% men, 79% persistent AF, LVEF 33% interquartile range (IQR) (25–38)] undergoing first time AF ablation were investigated. Identification of LA fibrosis and selection of ablation strategy were based on sinus rhythm voltage mapping. Continuous rhythm monitoring was used to assess ablation success. Improvement in post-ablation LVEF was measured as primary study endpoint. An absolute increase in post-ablation LVEF ≥10% was defined as ‘Super Response’. Left atrial fibrosis was present in 38% of patients. After ablation LVEF increased by absolute 15% (IQR 6–25) (P &lt; 0.001). Left ventricular ejection fraction improvement was higher in patients without LA fibrosis [15% (IQR 10–25) vs. 10% (IQR 0–20), P &lt; 0.001]. An inverse correlation between LVEF improvement and the extent of LA fibrosis was found (R2 = 0.931). In multivariate analysis, the presence of LA fibrosis was the only independent predictor for failing LVEF improvement [odds ratio 7.2 (95% confidence interval 2.2–23.4), P &lt; 0.001]. Echocardiographic ‘Super Response’ was observed in 55/64 (86%) patients without and 21/39 (54%) patients with LA fibrosis, respectively (P &lt; 0.001). Conclusion Presence and extent of LA fibrosis predict LVEF response in HF patients undergoing AF ablation. The assessment of LA fibrosis may impact prognostic stratification and clinical management in HF patients with AF.

scholarly journals Adaptive servo ventilation for sleep apnoea in heart failure: the FACE study 3-month data

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2021-217205
Author(s):  
Renaud Tamisier ◽  
Thibaud Damy ◽  
Sebastien Bailly ◽  
Jean-Marc Davy ◽  
Johan Verbraecken ◽  
...  
Keyword(s):  
Heart Failure ◽  
Latent Class ◽  
Systolic Heart Failure ◽  
Sleep Apnoea ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep ◽  
The Face

RationaleAdaptive servo ventilation (ASV) is contraindicated in patients with systolic heart failure (HF) who have a left ventricular ejection fraction (LVEF) below 45% and predominant central sleep apnoea (CSA). However, the effects of ASV in other HF subgroups have not been clearly defined.ObjectiveThe European, multicentre, prospective, observational cohort trial, FACE, evaluated the effects of ASV therapy on morbidity and mortality in patients with HF with sleep-disordered breathing (SDB); 3-month outcomes in patient subgroups defined using latent class analysis (LCA) are presented.MethodsConsecutive patients with HF with predominant CSA (±obstructive sleep apnoea) indicated for ASV were included from 2009 to 2018; the non-ASV group included patients who refused/were noncompliant with ASV. The primary endpoint was time to composite first event (all-cause death, lifesaving cardiovascular intervention or unplanned hospitalisation for worsening of chronic HF).Measurements and main resultsBaseline assessments were performed in 503 patients, and 482 underwent 3-month follow-up. LCA identified six discrete patient clusters characterised by variations in LVEF, SDB type, age, comorbidities and ASV acceptance. The 3- month rate of primary outcome events was significantly higher in cluster 1 patients (predominantly men, low LVEF, severe HF, CSA; 13.9% vs 1.5%–5% in other clusters, p<0.01).ConclusionFor the first time, our data identified homogeneous patient clusters representing clinically relevant subgroups relating to SDB management in patients with HF with different ASV usage, each with a different prognosis. This may improve patient phenotyping in clinical practice and allow individualisation of therapy.

Abstract 15065: Impact of Ablation Strategy on Left Ventricular Function Following Catheter Ablation in Patients With Long-standing Persistent Atrial Fibrillation and Heart Failure: Results From a Single-center Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
CHINTAN G TRIVEDI ◽  
Faiz Baqai ◽  
Domenico G Della Rocca ◽  
Carola Gianni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Background: Ablation strategy for long-standing persistent atrial fibrillation (LSPAF) is highly variable with diverse outcomes. Objective: We evaluated the change in left ventricular ejection fraction (LVEF) with different ablation approaches in LSPAF patients with heart failure (HF). Methods: Consecutive LSPAF patients with HF (LVEF <40%) undergoing their first catheter ablation at our center were included in the analysis. Based on the ablation strategy determined by the operators, patients were classified into two groups; group 1: received standard ablation (PV isolation+ isolation of left atrial posterior wall and superior vena cava) and group 2: standard ablation plus isolation of coronary sinus (CS) and left atrial appendage (LAA). High-dose isoproterenol challenge (20-30 μg for 10-15 min) was utilized to reveal LAA and CS triggers; electrical isolation was the procedural endpoint for LAA and CS ablation. If PVs were electrically silent due to presence of severe scar, LAA and CS were empirically isolated even in the absence of detectable triggers. LVEF was measured by transesophageal echocardiogram (TEE) performed at baseline and 6 months post-ablation. Patients were monitored for arrhythmia-recurrence off-antiarrhythmic drugs (AAD) as per our standard protocol. Results: Group 1 included 52 patients and group 2 had 106. Baseline characteristics were comparable across groups (age: 66.2 ± 7.3 and 64.4 ± 9.4; male: 41 (78.8%) and 87 (82.1%); BMI: 32.3 ± 6.8 and 30.4 ± 6.4 in group 1 and 2). Mean baseline LVEF (%) was 36.2±5.5 and 35.1±8.3 in group 1 and 2 respectively (p=NS). At the 6-month TEE, mean LVEF was significantly higher than the baseline value in group 2 (47.7±11 vs 35.1±8.3, p<0.001), whereas in group 1, although there was a positive trend, the change was statistically non-significant (39.4±10 vs. 36.2±5.5, p=0.36). A total of 7 (13.5%) patients from group 1 and 89 (84%) from group 2 were arrhythmia-free off-AAD at 1.5 year of follow-up (p<0.001). Conclusion: In our study population, ablation strategy including LAA and CS isolation along with the standard ablation resulted in significant improvement in the LVEF as well as higher rate of arrhythmia-free survival.

scholarly journals The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

2022 ◽  
Vol 11 (2) ◽  
pp. 300
Author(s):  
Albert Youngwoo Jang ◽  
Woong Chol Kang ◽  
Yae Min Park ◽  
Kyungeun Ha ◽  
Jeongduk Seo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Original Definition

The association between congestive heart failure (CHF) of the CHA2DS2-VASc scores and thromboembolic (TE) events in patients with atrial fibrillation (AF) is a topic of debate due to conflicting results. As the importance of diastolic impairment in the occurrence of TE events is increasingly recognized, it is crucial to evaluate the predictive power of CHA2DS2-VASc scores with C criterion integrating diastolic parameters. We analyzed 4200 Korean nonvalvular AF patients (71 years of age, 59% men) to compare multiple echocardiographic definitions of CHF. Various guideline-suggested echocardiographic parameters for systolic or diastolic impairment, including left ventricular ejection fraction (LVEF) ≤ 40%, the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E’) ≥ 11, left atrial volume index > 34 mL/m2, and many others were tested for C criteria. Multivariate-adjusted Cox regression analysis showed that CHA2DS2-VASc score was an independent predictor for composite thromboembolic events only when CHF was defined as E/E’ ≥ 11 (hazard ratio, 1.26; p = 0.044) but not with other criteria including the original definition (hazard ratio, 1.10; p = 0.359). Our findings suggest that C criterion defined as diastolic impairment, such as E/E’ ≥ 11, may improve the predictive value of CHA2DS2-VASc scores.

P2451Patterns of left atrial structural and functional remodeling after catheter ablation in paroxysmal and long-standing persistent atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
Z Balogh ◽  
E Stefanidis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Contractile Function ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Functional Remodeling

Abstract Background Both atrial fibrillation (AF) and catheter ablation (CA) may be associated with changes in left atrial (LA) structure and function. However, the data describing acute and short-term effects of CA on LA contractile function in different sub-types of AF are scarce. Purpose First, to describe patterns of LA structural and functional remodeling in patients with paroxysmal AF (PAF) or long-standing persistent AF (LSPAF) undergoing first or redo CA. Second, to assess clinical feasibility of LA strain and strain rate (SR) to monitor effect of AF and CA on LA contractile function. Methods We prospectively enrolled 138 consecutive patients (age: 63±21 years, 32% females) with PAF undergoing first (81%) or redo (19%) CA during sinus rhythm, and 20 individuals (age: 66±23 years, 20% females) with LSPAF undergoing first CA during AF. All patients were symptomatic and preserved (≥50%) left ventricular ejection fraction. Control group consisted of 23 healthy controls. All patients underwent comprehensive echocardiography one day pre-CA and post-CA, and at 3 month follow-up. The LA reservoir, conduit and contractile longitudinal strain (LAS) and LASR were assessed using 2D speckle tracking echocardiography as average of segmental values in apical views. Results A total of 14 (9%) patients had insufficient image quality for LA assessment and were excluded (feasibility: 91%). Pre-CA, patients with LSPAF showed the largest left atrial volume index (LAVI) (45±14 ml/m2), followed by PAF (35±8 ml/m2) and controls (24±10 ml/m2) (p<0.001). The lowest reservoir and contractile LAS was observed in patients with LSPAF (12±5% and 0%), followed by PAF undergoing redo CA (22±7% and 9±4%), versus first CA (27±8% and 13±4%) and controls (37±7% and 16±4%) (p<0.001). LASR followed similar trend. Post-CA, we observed acute increase of LAVI in all groups (figure 1). Reservoir and contractile LAS and LASR decreased only in patients with PAF who underwent first CA. In contrast, it remained unchanged in individuals with PAF who had redo CA or even increased in subjects with LSPAF (figure 2). At 3 month follow-up, LAVI was significantly reduced compared with baseline in all groups of patients with AF (p<0.01). In contrast, LAS and LASR did not show uniform improvement in all AF groups and on average they remained significantly lower compared with controls (p<0.01). The lowest LAS and LASR values were observed in patients with PAF who underwent redo CA (no improvement from baseline) and in patients with LSPAF (significant improvement versus baseline) (figure 2). Patients with PAF who had the first CA showed higher LAS and LASR compared with other two AF groups (p<0.01) but still significantly lower than controls (p<0.01). Conclusion Different sub-types of AF show different patterns of LA structural and functional remodeling after CA. Both reservoir and contractile LAS appear highly feasible and reproducible to monitor LA contractile function in this clinical setting.

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